Using 2014-2016 claims data from a random 5% sample of Medicare beneficiaries, we sought to describe characteristics associated with initiation of a SLT2i or GLP-1RA, focusing on measures of plan generosity (e.g., the number of drugs covered with no or minimal copays). Our cohort included beneficiaries with type 2 diabetes who had at least 1 prescription claim for an oral diabetes medication in the 180 days before the start of follow-up (1/1/2015). To identify new initiators of these agents, we excluded beneficiaries who filled any insulin, SGLT2i or GLP-1RA prior to the index date or who died before 12/31/16. We developed multivariable logistic regression models controlling a priori for age, race, region, prior medication use, claims-based measures of diabetes severity and clinical comorbidities, provider specialty and measures of formulary generosity. Of 103,112 eligible beneficiaries (mean age 73, 57% female), 5,076 (4.9%) initiated a SGLT2i or GLP-1RA between 1/1/15-12/31/16. After adjusting for all baseline characteristics, beneficiaries in plans covering 2 or more target drugs in preferred tiers (i.e., 1-3) were more likely (adjusted odds ratio [aOR] 1.18 [95% CI, 1.05 to 1.32]) to initiate one of these medications than patients enrolled in plans covering 0 drugs. Other characteristics associated with higher odds included: age<65 (aOR 1.78 [95% CI, 1.64 to 1.92]), diabetic retinopathy (aOR 1.19 [95% CI, 1.08 to 1.31], obesity (aOR 1.49 [95% CI, 1.38 to 1.62) and having baseline medications prescribed by an endocrinologist (aOR 1.68 [95% CI, 1.49 to 1.89]. Black race (aOR 0.66 [95% CI, 0.60 to 0.73]) and CKD (aOR 0.84 [95% CI, 0.76 to 0.92]) were associated with lower risk of initiation. After controlling for a large number of prespecified covariates, Medicare beneficiaries with type 2 diabetes with more generous prescription drug coverage were more likely to initiate a SGLT2i or GLP-1RA.


J. Luo: Consultant; Self; Alosa Health. I. Hernandez: None. N. Gabriel: None. W.F. Gellad: None.


National Center for Advancing Translational Sciences (KL2TR001856)

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at